Implementation of a standardised annual anticoagulation specialist review in primary care

Nathan Hutchinson-Jones, Sophie Didcott, Matthew Jones, Josephine Crowe

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Abstract

There are an increasing number of patients being prescribed direct oral anticoagulants (DOACs), while patients who remain on warfarin are becoming more complex. There is currently a lack of a standardised anticoagulation review for patients in primary care, resulting in potentially preventable harm events. Our aim was to implement a new service, where a standardised review is carried out by a specialist multidisciplinary secondary care anticoagulation team. Overall, implementation of a standardised review resulted in better optimisation of anticoagulation management for patients taking either a DOAC or warfarin. Out of 172 eligible patients prescribed warfarin, 47 (27%) chose to switch a DOAC. The average time in therapeutic range for patients on warfarin before and after the pilot increased from 73.5% to 75%. Out of 482 patients taking a DOAC, 35 (7%) were found to be on the incorrect dose. In 32 out of 35 patients (91%) the dose was amended after notifying the patient’s general practitioner. We also found a significant number of patients inappropriately prescribed concomitant medication such as antiplatelets or non-steroidal anti-inflammatory drugs, potentially putting patients at an elevated risk of bleeding. Whilst be it further research is needed; we believe the results of this pilot can be used to help build a case to influence commissioning of anticoagulation services. Secondary care anticoagulation teams, like our own, may be well placed to provide or support such services, working across the primary care: secondary care interface alongside our primary care colleagues.
Original languageEnglish
Article numbere17
JournalPrimary Health Care Research and Development
Volume21
Early online date9 Jun 2020
DOIs
Publication statusPublished - 2020

Keywords

  • Anticoagulant
  • Anticoagulants
  • anticoagulation
  • direct oral anticoagulants
  • Warfarin
  • review
  • service development

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